| NPI | 1548243090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 40510) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 3243) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 3243) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 25136) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MS 25136) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2022-01-25 |